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Nie JB, Cheng Y, Zou X, et al. The vicious circle of patient-physician mistrust in China: health professionals' perspectives, institutional conflict of interest, and building trust through medical professionalism. Dev World Bioeth. 2017;18(1):26-36doi: 10.1111/dewb.12170.
Nie, J. B., Cheng, Y., Zou, X., Gong, N., Tucker, J. D., Wong, B., & Kleinman, A. (2018). The vicious circle of patient-physician mistrust in China: health professionals' perspectives, institutional conflict of interest, and building trust through medical professionalism. Developing world bioethics, 18(1), 26-36. https://doi.org/10.1111/dewb.12170
Nie, Jing-Bao, et al. "The vicious circle of patient-physician mistrust in China: health professionals' perspectives, institutional conflict of interest, and building trust through medical professionalism." Developing world bioethics vol. 18,1 (2018): 26-36. doi: https://doi.org/10.1111/dewb.12170
Nie JB, Cheng Y, Zou X, Gong N, Tucker JD, Wong B, Kleinman A. The vicious circle of patient-physician mistrust in China: health professionals' perspectives, institutional conflict of interest, and building trust through medical professionalism. Dev World Bioeth. 2018 Mar;18(1):26-36. doi: 10.1111/dewb.12170. Epub 2017 Sep 18. PMID: 28922547.
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Dev World Bioeth. 2018 Mar;18(1):26-36. doi: 10.1111/dewb.12170. Epub 2017 Sep 18.

The vicious circle of patient-physician mistrust in China: health professionals' perspectives, institutional conflict of interest, and building trust through medical professionalism.

Developing world bioethics

Jing-Bao Nie, Yu Cheng, Xiang Zou, Ni Gong, Joseph D Tucker, Bonnie Wong, Arthur Kleinman

PMID: 28922547 DOI: 10.1111/dewb.12170

Abstract

To investigate the phenomenon of patient-physician mistrust in China, a qualitative study involving 107 physicians, nurses and health officials in Guangdong Province, southern China, was conducted through semi-structured interviews and focus groups. In this paper we report the key findings of the empirical study and argue for the essential role of medical professionalism in rebuilding patient-physician trust. Health professionals are trapped in a vicious circle of mistrust. Mistrust (particularly physicians' distrust of patients and their relatives) leads to increased levels of fear and self-protection by doctors which exacerbate difficulties in communication; in turn, this increases physician workloads, adding to a strong sense of injustice and victimization. These factors produce poorer healthcare outcomes and increasingly discontented and angry patients, escalate conflicts and disputes, and result in negative media coverage, all these ultimately contributing to even greater levels of mistrust. The vicious circle indicates not only the crisis of patient-physician relationship but the crisis of medicine as a profession and institution. Underlying the circle is the inherent conflict of interest in the healthcare system by which health professionals and hospitals have become profit-driven. This institutional conflict of interest seriously compromises the fundamental principle of medical professionalism-the primacy of patient welfare-as well as the traditional Chinese ideal of "medicine as the art of humanity". Patient trust can be restored through rectifying this institutional conflict of interest and promoting medical professionalism via a series of recommended practical measures.

© 2017 John Wiley & Sons Ltd.

Keywords: China; health professionals; medical professionalism; patient-physician relationship; professional ethics; trust and mistrust

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